Forms

If you can’t find the form you seek in the list below, please contact us at medicalrecords@nd.edu or at (574) 631-7497. We’ll make sure you obtain the necessary paperwork.

Student medical services are confidential. In accordance with Indiana state and federal laws governing privacy, University Health Services (UHS) will not share a student’s information outside of the healthcare community without a student’s express permission. However, in the event of an emergency, a family member or guardian will be notified promptly if a student is in immediate danger or admitted to a hospital or other healthcare facility.

Please note: In order to use our forms, you’ll need Adobe Reader.

• Authorization Form for Consent for Treatment of a Minor
• Consent to Acquire Information from Medical Records to Release to UHS
• Information and Forms for Students on Allergy Immunotherapy
• Immunization Form
• Medical Records Release Form (use when requesting UHS medical records be sent to any medical practice)
• Prescribed Stimulant Medication Form
• Vaccine Exemption Request Form
• Summer Scholar and Leadership Seminar Exemption Request Form
• ND Wellness Center Eligibility Link to Sign Up Dependents

For Notre Dame Student-Athletes:

Your Athletic Trainer will contact you with the necessary forms.